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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effect of Periglossal Electrical Stimulation on Haemodynamic Parameters in Stroke Patients- An Experimental Study
Correspondence Address :
Dr. Jasobanta Sethi,
Director and Professor, Amity Institute of Physiotherapy, Amity University, Sector 125,
Noida-201313, Uttar Pradesh, India.
E-mail: jsethi@amity.edu
Introduction: Tongue stimulation has been used in rehabilitation of wide variety of patients like sleep apnea, multiple sclerosis and stroke patients. It helps in improving swallowing functions, balance and reducing sleep apnea symptoms. Tongue stimulation is also being used in stroke rehabilitation for improving balance.
Aim: To find out the effect of periglossal electrical stimulation on haemodynamic parameters in stroke patients.
Materials and Methods: The present study was an experimental study in which, 30 stroke patients in the age group of 30-60 years, admitted during the period between October 2020-March 2021, were included. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Respiratory Rate (RR) and oxygen saturation were measured before stimulation. All patients were given 15 minutes of tongue stimulation once. All the haemodynamic parameters were measured during the stimulation, immediately after tongue stimulation and 15 minutes after the completion of stimulation.
Results: There were 15 males and 15 females in the study. There were no significant changes in HR, RR and oxygen saturation during tongue stimulation (p>0.05). Although, there were statistically significant changes in SBP, DBP during tongue stimulation, they were clinically insignificant and returned to baseline within 15 minutes after stimulation.
Conclusion: Tongue stimulation has been found to be safe and effective for rehabilitation of stroke patients with respect to haemodynamic variables.
Blood pressure, Heart rate, Oxygen saturation
Stroke is one of the leading causes of morbidity and mortality in the world (1). Approximately, 40-60% of stroke patients remain dependent at six months after stroke and 33-59% of the patients remain dependent at one year (2). Multidisciplinary approach and consistent rehabilitation are needed to decrease the disability of the patients (2). Various therapeutic techniques have been used to rehabilitate the stroke patients. Tongue stimulation has been used in wide variety of neurological conditions like parkinsonism, multiple sclerosis, spinal cord injury, traumatic brain injury and stroke patients for improving balance, gait, eye movement control, cognitive functions and speech (3). Tongue stimulation has also been used to induce neuroplasticity in stroke patients (3),(4),(5). Tongue is unique with rich innervation where sensory supply is provided by trigeminal, facial and glossopharyngeal nerve and hypoglossal nerve provides motor supply and vagus nerve supplies posterior most aspect of the tongue (6).
Tongue stimulation has been found to reduce HR variability and reduce hypoxia in sleep apnea patients (7). Tongue position also influences the whole body (8). This position alters with emotions and mental state, thus proving as an instrument for psychological observation; feeling of fear places the tongue anteriorly (8). When the tongue is positioned against the palate, the parasympathetic system decreases its systemic activity, but if it is positioned against the soft palate, the reverse happens (9),(10). Tongue, in addition to alimentary functions and phonation, functions as one of the important accessory muscles of respiration that helps to stiffen the upper airway walls and enlarge the upper airway lumen (8),(11).
Moreover, studies have been undertaken to find out the effect of tongue stimulation along with rehabilitation techniques in improving motor functions in stroke patients. The purpose of this study was to understand the effect of tongue stimulation on haemodynamic parameters in stroke patients, as hardly any study has been done on this aspect.
This experimental study, with pre-postexperimental design was conducted between October 2020-March 2021, in Narayana Superspecialty Hospital, Gurugram, Haryana, India. This was approved by Institutional Ethics Committee (IEC) of Narayana Superspecialty Hospital, Gurugram, Haryana and Amity University, Uttar Pradesh, Noida (AUUP/IEC/2018-AUG/06). Thirty subacute stroke patients in the age group of 30-60 years of age and both genders were included in the study after obtaining informed consent.
Inclusion criteria: Patients in subacute stage of recovery (between 2 weeks to 4 weeks after stroke onset) and who were clinically stable to undergo rehabilitation were included in the study.
Exclusion criteria: Patients with arrhythmias, history of seizures, history of head and neck surgery, and dysphagic patients were excluded from the study.
Comprehensive assessment of patients was done which includes HR, SBP, DBP, RR and oxygen saturation. Patients were given 15 minutes of electrical stimulation (Healer Combo Therapy Machine) using pen electrode at the frequency of 20 Hz (hertz), pulse width of 200 milliseconds and intensity set according to the tolerable threshold of the patients which ranged between 2.5 mA (milliampere) to 3.5 mA (12). Tongue stimulation has been given as a part of the rehabilitation protocol which has got approval from IEC of Amity University, Noida, Uttar Pradesh and Narayana Health. Cardiopulmonary parameters were assessed during the tongue stimulation (5 minutes after the initiation of tongue stimulation), immediately after tongue stimulation and 15 minutes after completion of tongue stimulation. Tongue was examined after the stimulation for any evidence of redness.
Statistical Analysis
Data was analysed using Statistical Analysis System (SAS) software 9.4 version. Demographic data was represented by means of descriptive statistics. Repeated measures ANOVA analysis was used to analyse the mean changes in HR, SBP, DBP, RR and oxygen saturation.
Thirty stroke patients in the age group of 30-60 years were included in the study. The mean age was 56.03±2.72 years and there were 15 males and 15 females.
There were no significant changes in HR, RR and oxygen saturation of the patients during tongue stimulation (Table/Fig 1), (Table/Fig 2). There was a mild decrease in mean HR (2 beats) which returned to normal immediately after the stimulation, whereas the RR and oxygen saturation remained the same during the tongue stimulation. Although, there were statistically significant increase in SBP, DBP during tongue stimulation, they were clinically insignificant and repeated measures analysis revealed that SBP, DBP returned to baseline within 15 minutes after tongue stimulation (p>0.05) (Table/Fig 1),(Table/Fig 2).
Electrical stimulation of tongue has been used in rehabilitation of various kinds of patients. The results of the study showed that there were no significant changes in HR, RR and saturation of the patients during tongue stimulation. Mean changes in HR were less than 2 beats during stimulation and there were no changes in RR and saturation during stimulation. Although, there were statistically significant changes in SBP and DBP during tongue stimulation, they were clinically insignificant and repeated measures analysis revealed that SBP and DBP returned to baseline within 15 minutes after tongue stimulation (Table/Fig 1),(Table/Fig 2). Mean changes in SBP were around 6 mmHg during stimulation but it returned to baseline within 15 minutes after stimulation. Similarly, mean changes in DBP were less than 3 mmHg during stimulation which was clinically insignificant (Table/Fig 1),(Table/Fig 2).
Tongue stimulation, given to anterior 2/3rd of the tongue, can stimulate parasympathetic system and can slower HR (13). However, since the tongue stimulation was given for a shorter period and intermittent stimulation was given, it did not cause any significant change in HR. Thus, there was no effect of tongue stimulation on the autonomic nervous system and no significant changes in haemodynamics of the patients. The results were similar to the study done by the Shi X et al., where tongue acupuncture did not cause any significant changes in HR and BP (14).
Electrical stimulation of the lingual nerve in cats (which carries the sensation to brain through trigeminal and facial nerve) evoked blood flow increases in lower lip and palate, which is reduced by simultaneous Cervical Sympathetic Trunk (CST) stimulation (15). CST stimulation evoked vasoconstriction in tongue (9). This could be plausible explanation for the insignificant changes in BP during tongue stimulation in human.
Tongue can be used as a useful interface for inducing neuroplasticity in stroke patients through electrical stimulation as it does not cause clinically significant haemodynamic changes. Combination of the tongue stimulation along with balance exercises, swallowing exercises, and upper limb exercises can improve respective functions and further studies can be done to explore its benefits.
Limitation(s)
The study was limited by a smaller sample size.
This study shows that tongue stimulation has been proved to be a safe technique in stroke rehabilitation with respect to haemodynamic variables. Further follow-up study can be done in a larger sample size and different age groups in order to generalise the results of the study.
Authors contribution: JJ- Conducted the study, written the manuscript. JS- Conceptualised the study, guided in making the study protocol and writing the manuscript. SK-Screening the patients and provided inputs in execution of the study. SG- Provided inputs in study protocol and manuscript writing. TM- Helped in screening the stroke patients and has provided inputs in execution of the study.
DOI: 10.7860/JCDR/2022/53183.15864
Date of Submission: Nov 11, 2021
Date of Peer Review: Nov 30, 2021
Date of Acceptance: Dec 14, 2021
Date of Publishing: Jan 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 12, 2021
• Manual Googling: Dec 09, 2021
• iThenticate Software: Dec 30, 2021 (12%)
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